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Review
. 2024 Dec;11(6):1441-1456.
doi: 10.1007/s40744-024-00722-w. Epub 2024 Oct 18.

How Are We Addressing Axial Psoriatic Arthritis in Clinical Practice?

Xabier Michelena  1 , Clementina López-Medina  2 , Eugenio De Miguel  3 , Manuel José Moreno-Ramos  4 , Rubén Queiro  5 , Helena Marzo-Ortega  6 , Xavier Juanola  7
Affiliations
Review

How Are We Addressing Axial Psoriatic Arthritis in Clinical Practice?

Xabier Michelena et al. Rheumatol Ther. 2024 Dec.

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory disease affecting the musculoskeletal system, skin and nails. In addition to peripheral joints, inflammation of the spine and sacroiliac joints may occur. Yet, research into this axial phenotype has lagged behind partly because of the challenge in its clinical identification with a lack of specific clinical, molecular or imaging biomarkers. In the absence of a validated definition of what constitutes axial PsA (axPsA), guidelines for the management of axial involvement in PsA in clinical practice are scarce. On the basis of a literature review and their clinical expertise, a group of rheumatology experts provide their opinion to aid the diagnosis and management of axial PsA in clinical practice.

Keywords: Axial involvement; Axial psoriatic arthritis; Axial spondyloarthritis; Psoriatic arthritis; Psoriatic spondylitis; Sacroiliitis.

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Conflict of interest statement

Declarations Conflict of Interest Xabier Michelena has received speaking fees and honoraria as advisor from: Abbvie, Janssen, Lilly, Novartis and UCB. Clementina López Medina has received honoraria as speaker fees/consulting from: Abbvie, Janssen, Lilly, MSD, Novartis, Pfizer and UCB. Eugenio De Miguel has received research funding/consulting and conferences fees from: Abbvie, Novartis, Roche, Pfizer, Janssen, Lilly, MSD, BMS, UCB, Grunental and Sanofi. Manuel José Moreno Ramos has received unrelated honoraria or research grants from Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer and UCB, and advisor´s honoraria from Abbvie, Janssen, Lilly, Novartis, Pfizer and UCB unrelated to the present work. Rubén Queiro has received honoraria as a panellist, consultant, speaker and researcher from: Abbvie, Celgene-Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, and UCB. Helena Marzo-Ortega has received grant support from Janssen, Novartis, Pfizer and UCB. Honoraria and/or speaker fees from AbbVie, Amgen, Biogen, Eli-Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB. Xavier Juanola has received honoraria as a panellist, consultant, speaker or researcher from Abbvie, Lilly, MSD, Novartis, Pfizer and UCB. Ethical Approval This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Proposed workflow algorithm for axial psoriatic arthritis diagnosis. HLA-B27 human leukocyte antigen B27, IBP inflammatory back pain, MBP mechanical back pain, MRI magnetic resonance imaging, SIJ sacroiliac joints
Fig. 2
Fig. 2
A Lateral cervical spine radiography showing calcification in a patient with DISH. B Lateral lumbar radiography showing bridging syndesmophytes in a patient with DISH. C Lateral cervical spine radiography in a patient with axial psoriatic arthritis. D Lateral lumbar radiography in a patient with axial psoriatic arthritis. E Lateral cervical spine radiography in a patient with ankylosing spondylitis. F Lateral thoracic spine radiography in a patient with ankylosing spondylitis
Fig. 3
Fig. 3
Therapeutic algorithm for patients with axial psoriatic arthritis. *Preferred in the presence of relevant skin involvement; however, in case of concomitant inflammatory bowel disease or uveitis, an anti-TNF antibody would be preferred. NSAIDs non-steroid anti-inflammatory drugs, GC injections glucocorticoids injections, IL-17i interleukin-17 inhibitors, TNFi tumour necrosis factor inhibitors, JAKi Janus kinase inhibitors, bDMARD biologic disease-modifying antirheumatic drug, anti-TNF anti-tumour necrosis factor
See this image and copyright information in PMC

References

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